Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

8
The Excessive Demand for Medical Care

You can't take care of everyone. The demand for medical care is infinite.

-- Enoch Powell, U.K. Minister of Health Affairs

Having discussed the amazing ability of physicians to generate additional demand, to the point that even greatly overstaffed specialties have very high average earnings, we now turn to consumer demand for medical care. We seek to understand, first, how consumers can be persuaded to increase their demands at the will of the supplier and, second, how excessive demand is independent of the influence of the health care industry.

It is difficult to distinguish between the excessive demands of consumers for medical services and the ability of an oversupply of M.D.s to generate additional demand for their services. 1 But there are limits to supply-induced demand, and we foresee M.D.s joining lawyers as disaster-mongers. On the one hand, without autonomous excess demand, some of the oversupply cannot occur. On the other hand, without an excess supply, excessive demands cannot be met. They are interdependent. There is some implicit collusion. The decision to see a physician in the first place is entirely up to the consumer. But what happens next is at the suggestion of the M.D. and the discretion of the customer. Better-informed individuals use more medical care. But the effect of their information on number of follow-up visits is negligible. 2


Demand and Prices

Suppliers and consumers share many of the same attitudes. Neither is constrained by price, only by insurance coverage. Even medical costs, that is,

-123-

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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